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Coronavirus: Medicare coverage

Written by Diane Archer

The Centers for Medicare and Medicare Services and Congress have expanded Medicare coverage to help the 60 million older adults and people with disabilities who might need testing and treatment for the novel coronavirus and other health care services. People over 65 and people with disabilities are at particular risk if they get the virus.

There is no vaccine or cure for COVID-19, the respiratory disease caused by the new coronavirus. People with fever, cough and other serious symptoms should quarantine themselves and, if they are having difficulty breathing, should get tested. If necessary, they should also have their symptoms treated.

What is covered: Medicare Part B covers the full cost of testing, whether you are in traditional Medicare or a Medicare Advantage plan. For Medicare to pay, your doctor must order the testing. You pay no deductibles or coinsurance.

Congress just passed a new law fully covering testing-related services, whether you are enrolled in traditional Medicare or a Medicare Advantage plan. And, Medicare Advantage plans cannot require prior authorization or other utilization management tools in order for people to receive these services. These services include the doctor visit, in person or electronically, and emergency department services. These are services that lead to the ordering or administering of the test.

All Medicare inpatient and outpatient services continue to be covered. You are covered for all medically necessary services, including hospitalization, therapy, skilled nursing and home health care. Please click on the links to understand the scope of coverage. For skilled nursing facility care, Medicare has waived the three-day prior hospitalization requirement.

Federal legislation also now allows Part B coverage for telehealth services for people in traditional Medicare during this emergency. Coverage is available no matter what health care services you need, related or unrelated to the coronavirus, including an office visit, mental health care and preventive care.

The federal government has required Medicare Advantage plans to cover people’s out-of-network care from Medicare-participating facilities at the same cost as at in-network families. If you are enrolled in a Medicare Advantage plan, simply see any doctor or use any hospital that takes Medicare. About 95 percent of doctors and hospitals do. You do not need a referral.

If there is a coronavirus vaccine, Medicare will cover it. It might be covered under Part B or Part D. And, there may be a deductible or copays.

As for drugs, the federal government has not mandated that the Part D prescription drug insurers allow people to secure more drugs than usually permitted during this time of emergency. The Centers for Medicare and Medicaid Services simply states that it expects them to. Call your Part D insurer to find out whether you can get an extended supply of your drugs.

What will you pay: If you are enrolled in a Medicare Advantage plan and you follow plan rules, you will be responsible for the deductible and copays up to the plan maximum, which can be no higher than $6,700 a year.

If you are enrolled in traditional Medicare and do not have supplemental coverage to fill gaps–Medigap, retiree coverage or Medicaid–for inpatient hospital care, you will be responsible for the Medicare Part A deductible of $1,408 for each benefit period in 2020. After 60 days, you also must make a daily $352 copayment through day 90.  If you are quarantined in the hospital, you have no further financial responsibilities.

If you were admitted to a skilled nursing facility, your copayments would be $176 a day for days 21-100.

There is no limit on out-of-pocket costs if you are in traditional Medicare and do not have supplemental coverage. And, Medicare Advantage HMO plans can charge deductibles and copays up to $6,700 for in-network approved services. If you are enrolled in a PPO, the cap on out-of-network care is $10,000.

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